活动感染性自体二尖瓣心内膜炎外科治疗的系统评价

Surgical treatment of active native mitral infective endocarditis： A meta-analysis of current evidence

目的 系统评价二尖瓣成形术和置换术治疗活动感染性自体二尖瓣心内膜炎的近远期疗效.方法 应用Meta分析方法对所入选文献的研究结果进行定量综合分析;应用Review manager 5.3软件进行异质性检验及合并OR、HR值和95％置信区间的计算,并进行敏感性分析及发表偏倚分析.结果 本研究共纳入8组数据,均是回顾性病例对照研究,总病例667例,其中二尖瓣成形组294例、二尖瓣瓣膜置换组373例.术后结局指标及95％的可信区间分别为：手术死亡率OR =0.49,95％CI 0.27～0.88,P=0.02;1年、5年无症状生存率HR值分别为HR=0.46,95％CI 0.21～1.03,P=0.06,HR =0.42,95％CI 0.24～0.76,P=0.004;1年、5年生存率HR值分别为HR =0.53,95％CI 0.23～1.21,P=0.13,HR =0.52,95％CI 0.29～0.94,P=0.03.结论 该系统评价提示,在活动感染性自体二尖瓣心内膜炎的外科治疗中,与二尖瓣置换相比较,二尖瓣成形术并没有增加近远期生存风险.

Objective To systemically assess impact on short- and long-term results of mitral valve repair（MVP） and replacement（MVR） for active native mitral infective endocarditis（ANMIE）. Methods A metaanalysis was performed on the comparison and synthesis of findings from included studies published. Pooled odds ratio（OR ） or Hazard rate（HR ） and 95% confidence interval（C/） were calculated using RevMan 5.3 software. Sensitivity analysis was conducted and possible publication bias was tested as well. Results Eight retrospective studies including 667 patients （294 MVP group, 373 MVR group） were eligible for inclusion. The summary odds ratio for operative, comparing repair to replacement was （OR=0.49, 95%CI 0.27-0.88, P=0.02）. The summary 1,5 year survival hazard rate was （HR=0.46, 95%CI 0.21-1.03, P=0.06, HR=0.42, 95%CI 0.24-0.76, P= 0.004）, respectively （repair vs. replacement）. The summary 1, 5 year event-free survival hazard rate was （HR= 0.53, 95%CI 0.23-1.21, P=0.13, HR=0.52, 95%CI 0.29-0.94, P=0.03）, respectively （repair vs. replacement）. Conclusion Mitral valve repair cannot increase the risk of short- and long-term results among patients undergoing surgery for ANMIE. Mitral valve repair is the preferable surgical treatment option for it. [